Does Medicare Cover Sleep Apnea?

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Medicare Part B, your medical insurance, covers sleep apnea, sleep studies, and doctor’s visits to treat the condition. Medicare also pays for a CPAP machine (or oral appliance) to help with breathing with a doctor’s prescription. Depending on your Medicare plan, you might be responsible for a percentage of the cost. 

What Is Sleep Apnea?

It’s a potentially severe sleep disorder in which breathing (involuntarily) frequently stops and starts. Your breathing could stop for a minute or longer, and you might stop breathing many times during the night.

More men have sleep apnea than women. Common symptoms include loud snoring and feeling tired even after a full night’s rest. Age and obesity are typical risk factors. 

Sleep Apnea Treatment

Treatment for sleep apnea usually includes lifestyle changes like weight loss and a breathing assistance device at night. For example, a continuous positive airway pressure (CPAP) machine uses a hose and mask (or nosepiece) to send steady air pressure into the throat to keep the airway from collapsing. In other words, the machine helps you sleep better, snore less, and prevent severe side effects of sleep apnea. Most CPAP masks can be adjusted for comfort. 

Without treatment, sleep apnea can cause high blood pressure, stroke, heart disease, diabetes, sleepiness, and depression.   

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Medicare Coverage for Sleep Apnea Treatment

Medicare covers 80% of a CPAP machine as “durable medical equipment”. To avoid extra costs, make sure your device comes from a DME supplier that accepts Medicare assignment.

If you have a Medicare Advantage plan, network restrictions, copays, and deductibles may apply. It’s best to check with your provider before scheduling a sleep study or buying equipment for treatment. Recipients with Medigap insurance may not be responsible for 20% of the bill.  

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Medicare CPAP Guidelines

  • There’s a three-month trial period where Medicare pays 80% of the cost to rent the machine, plus 80% of the cost of tubing, masks, and other necessary supplies.
  • Medicare will continue to cover your CPAP machine after the first three months — if your doc affirms that CPAP therapy is helping.
  • Medicare pays the supplier a rental fee for 13 months. After that, you own the CPAP machine.
  • If you had a CPAP device before you enrolled, Medicare may cover a replacement machine rental or accessories.

What Else Might Medicare Cover?

Item/Service Covered By Medicare?
Position therapy devices (“supine”)                                   YES
In-home sleep apnea testing                                   YES **
Sleep apnea mouthpiece                                   YES
CPAP cleaner                                   NO
Implantable pump refill                                   YES
Sleep apnea surgery                                   YES **

** when you meet certain criteria

Additional Medicare Insurance for Sleep Apnea 

Medicare Supplement (Medigap) plans can pay for what Original Medicare doesn’t, like deductibles, copayments, and coinsurance that you’d normally pay. With a Medigap policy, you can pick any doctor that accepts Medicare in the U.S.

Also, Medigap always accepts Medicare-approved services. At Bobby Brock Insurance, we’ll help you find a supplement policy that suits your needs and budget. Contact us online or call (662) 844-3300 for a FREE quote.  

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Justin Brock

President & CEO of Bobby Brock Insurance